title: Titrated oral misoprostol solution versus vaginal misoprostol for labor induction.
abstract: OBJECTIVE
  To determine the efficacy and safety of a titrated oral misoprostol solution compared with vaginal misoprostol tablets for labor induction.
  
  
  METHODS
  A randomized, triple-blind, multicenter clinical trial was conducted between March 2010 and June 2011. Women with a single gestation (n=200) were randomized to receive a titrated oral misoprostol solution (initial misoprostol dose 20 μg/hour; dose increased by 20 μg/hour every 6 hours up to 80 μg/hour for a maximum of 48 doses) or vaginal misoprostol tablets (25 μg of misoprostol every 6 hours for a maximum of 8 doses). Risk ratios (RR) and 95% confidence intervals (CIs) were calculated for maternal and perinatal outcomes.
  
  
  RESULTS
  The frequencies of vaginal delivery not achieved within 12 hours (RR 0.87; 95% CI, 0.62-1.22) and within 24 hours (RR 1.11; 95% CI, 0.83-1.49) were similar in the 2 groups. No differences were found in terms of uterine hyperstimulation, unfavorable cervix at 12 and 24 hours, oxytocin augmentation, tachysystole, epidural analgesia, adverse effects, and perinatal outcome. Approximately 70% of the women preferred the oral solution.
  
  
  CONCLUSIONS
  A titrated oral misoprostol solution was as effective and safe for labor induction as vaginal misoprostol tablets. ClinicalTrial.gov: NCT00 992524.
authors.affiliation: Department of Maternal and Child Health, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil; Emergency Obstetric Care, Policlínica e Maternidade Prof. Arnaldo Marques, Recife, Brazil; Department of Maternal and Child Health, Universidade Federal de Pernambuco, Recife, Brazil; Research Department, Instituto de Pesquisa Prof. Joaquim Amorim Neto, Campina Grande, Brazil; Emergency Obstetric Care, Hospital Barão de Lucena, Recife, Brazil. Electronic address: alexrolland@uol.com.br.
authors.forename: Alex S R
authors.initials: AS
authors.lastname: Souza
authors.forename: Francisco E L
authors.initials: FE
authors.lastname: Feitosa
authors.forename: Aurélio A R
authors.initials: AA
authors.lastname: Costa
authors.forename: Ana P R
authors.initials: AP
authors.lastname: Pereira
authors.forename: Andreza S
authors.initials: AS
authors.lastname: Carvalho
authors.forename: Renata M
authors.initials: RM
authors.lastname: Paixão
authors.forename: Leila
authors.initials: L
authors.lastname: Katz
authors.forename: Melania M R
authors.initials: MM
authors.lastname: Amorim
mesh_terms: D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D010121:Oxytocin / Q000008:administration & dosage* / Q000009:adverse effects; D057240:Patient Preference; D011247:Pregnancy; D011256:Pregnancy Outcome; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin
keywords: Clinical trial; Induced labor; Misoprostol